Discussion of public health and health care policy, from a public health perspective. The U.S. spends more on medical services than any other country, but we get less for it. Major reasons include lack of universal access, unequal treatment, and underinvestment in public health and social welfare. We will critically examine the economics, politics and sociology of health and illness in the U.S. and the world.

Tuesday, January 22, 2008

Freud was sorta kinda right, in a way

Okay, while the global economy collapses and the veep tries to get a war with Iran started while he's still got the chance, I'm going to plow ahead with the current program. Freud made a lot of mistakes, in substituting intuition for research and the specific culture of upper middle class turn of the century Vienna for all of human existence. No, it probably isn't your toilet training or your suppressed desire for your cousin that's responsible for your unhappiness, and all those profound symbols in your dreams are probably just meaningless brain spasms. He also seriously lost his when he decided that those tales her heard of childhood sexual abuse were actually fantasies.

However . . .

It is true that our consciousness offers only a tiny slit of a window into our mental processes. We are largely unaware of why we do what we do, and our free will is mostly, if not entirely, an illusion. Processes go on in the brain that result in decisions to act, that we become aware of only after they have been made. It appears to us that this conscious entity, this self-aware ego, exists somehow apart from the body, and controls its actions, but that is not how it works at all. Freud gave us an animal id and a socially created superego. Squeezed between the two, the ocean and the air, the soul drifted with wind and tide. The parsing of the psyche into those three parts was arbitrary. I would say that it reflected common assumptions about human nature as inherently amoral and requiring external force to control depravity, but the basic idea that the vast bulk of mental processes are not perceptible to consciousness was correct.

Nevertheless, when it comes to what we, as humans, value, it's what's in our consciousness that matters. Whatever it is that's making us want something, we experience desire. If we behave in a way we regret, it's the opposite of consolation, at least to me, that the behavior was generated by a process of which I was not conscious. I still want to do something about it, to behave less counterproductively in the future. The recognition that free will is illusory only means that change is is more difficult than I would like, it is not helpful as an excuse.

I apologize for the recent eruption of bullshit, but I'm still going someplace. More to follow.